Figure 2.

Endoscopic findings of airway and esophageal ischemia in the setting of TE fistula prior to bleeding event. These series of images were taken after the patient began violent coughing and choking following prior pulmonary intervention to denude, biopsy, and suction friable tissue to “clean” the airway plugging following radiation therapy. (A) Endobronchoscope mild ischemic changes along the posterior tracheal wall with the right and left main bronchi branching at the carina below; (B) necrotic white-yellow mucosa and cartilaginous tissue along the right proximal major bronchus at a closer view with hypervascularity; (C) erosion of the posterior tracheal cartilage near the right major bronchus branchpoint with esophageal pink mucosa jutting through. An ostia within the friable esophageal wall is appreciable in the middle of the tissue consistent with a communicating TE fistula. Abbreviation: TE, tracheoesophageal.